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Indian Journal of Orthopaedics Surgery


Management of infected TKR (total knee replacement) and results of two stage surgery for infected TKR


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Author Details: Mohit M. Patel, Kaushal R. Patel, Zulfikar M. Patel, Kalpesh A. Mehta

Volume : 2

Issue : 2

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 137

Article End Page : 142


Abstract

Background: Total knee Replacement is one of the common surgery for knee Osteoarthritis. Infection after total knee replacement is uncommon but disastrous complication.
Purpose: Main purpose of study is to determine functional results of two stage surgery in infected TKR, compare the results of two stage surgery with other modalities of treatment, risk factors for infections, role of laboratory and clinical markers for early diagnosis of infection in TKR.
Methods: This is retrospective study of 40 patients who operated for infected TKR through two stage revision arthroplasty. 
Inclusion criteria: All patients operated for infected TKR by two stage revision arthroplasty.

Exclusion criteria:

·         Less than 12 months follow up

·         Expired patients

Results: The average age of patients was 62.1 years. With youngest patient were being 40 years old and the oldest being 82.
Average BMI in our series was 27.07. It varied with a range from 19.9 to 38.67.
15 patients had diabetes mellitus (DM), 7 patients had hypertension and 1 patient had hypothyroidism.
The average WOMAC score improved from
 37.525 to 56.3 with a minimum pre op score of 30 and maximum of 45.
The mean clinical knee society score (KSS
 score) improved from from 50.1 to 69.325.
97% of patients showed improvement in their preoperative pain. 
The mean range of movement improved from 53.75 to 90.375. Pre op minimum ROM was 30 and maximum was 100.
The average extensor lag preoperatively was 6.65 degrees with a range of 0-15 degrees.
Patients showed improvement with average extensor lag reducing to 2.75 degree, with range of 0-10 degrees.
The failure rate of our study was 8% with persistent infection after treatment.

Conclusion: 

·         Pain is the most common indication for infected TKR.

·         Two stage revision arthroplasty in Infected TKR leads to significant improvement in pain, Range of motion and KSS and WOMAC scores.

·         Results of two stage revision arthroplasty are superior to any other treatment.

·         Most common organism is staphylococcus aureus.

·         Associated illness affects the results of treatment.

Key Word: Osteoarthritis, Total knee replacement, Infection, Kss score, Womac score